MacFarlane M P, Fraker D L, Shawker T H, Norton J A, Doppman J L, Chang R A, Skarulis M C, Marx S J, Spiegel A M, Alexander H R
Surgical Metabolism Section, National Cancer Institute, National Institutes of Health, Bethesda, Md 20892.
Surgery. 1994 Dec;116(6):959-64; discussion 964-5.
Neck reexploration for primary hyperparathyroidism has a lower success rate and greater morbidity than initial exploration because of scarring and distortion of tissue planes and the possibility of a parathyroid neoplasm located in an ectopic or unusual position. Although the use of standard noninvasive imaging studies for reoperative parathyroid surgical procedure is well accepted, the use of invasive studies to localize parathyroid neoplasms, particularly percutaneous aspiration of potential lesions, is controversial. In this report we analyze the results and morbidity in patients undergoing fine-needle aspiration before neck reexploration.
From 1982 to 1993, 255 patients underwent reexploration for persistent or recurrent hyperparathyroidism at the National Institutes of Health. Of these 255 patients 42 underwent 44 preoperative fine-needle aspirations by ultrasonography or computed tomography guidance in an attempt to localize a parathyroid neoplasm. The aspirated contents were then analyzed for parathyroid hormone content.
Of the 44 aspirations 26 (59%) were true positives with no false positives. Of 18 negative fine-needle aspirations, 11 (25%) were false negatives, and seven (16%) were true negatives. The specificity and sensitivity of percutaneous fine-needle aspiration were 100% and 70%, respectively.
Percutaneous fine-needle aspiration for parathyroid hormone is a safe, well-tolerated technique that is highly specific and allows a directed surgical resection avoiding further invasive workup when the aspirate is positive.
由于组织平面的瘢痕形成和变形以及甲状旁腺肿瘤位于异位或不寻常位置的可能性，原发性甲状旁腺功能亢进症的颈部再次探查手术成功率低于初次探查，且发病率更高。尽管标准的非侵入性影像学检查用于再次手术的甲状旁腺手术已被广泛接受，但使用侵入性检查来定位甲状旁腺肿瘤，特别是对潜在病变进行经皮穿刺抽吸，仍存在争议。在本报告中，我们分析了在颈部再次探查前接受细针穿刺抽吸的患者的结果和发病率。
1982年至1993年，255例患者在美国国立卫生研究院接受了持续性或复发性甲状旁腺功能亢进症的再次探查。在这255例患者中，42例患者在超声或计算机断层扫描引导下进行了44次术前细针穿刺抽吸，试图定位甲状旁腺肿瘤。然后对抽吸物进行甲状旁腺激素含量分析。
在44次抽吸中，26次（59%）为真阳性，无假阳性。在18次阴性细针抽吸中，11次（25%）为假阴性，7次（16%）为真阴性。经皮细针穿刺抽吸的特异性和敏感性分别为100%和70%。
经皮细针穿刺抽吸甲状旁腺激素是一种安全、耐受性良好的技术，具有高度特异性，当抽吸物为阳性时，可进行有针对性的手术切除，避免进一步的侵入性检查。
